Treatment of Strep Throat in Pregnant Women

First-Line Antibiotic Selection

The American College of Physicians and the Infectious Diseases Society of America recommend penicillin V (500 mg orally twice daily for 10 days) or amoxicillin (500 mg orally three times daily for 10 days) as first-line treatments for strep throat in pregnant women, due to their safety profile and efficacy 1, 2
Penicillin and cephalosporin antibiotics are considered the safest classes for treating bacterial pharyngitis during pregnancy, as they do not harm the fetus 1, 2
The Infectious Diseases Society of America guidelines establish penicillin as the drug of choice for group A streptococcal pharyngitis due to its narrow spectrum of activity, with a recommended regimen of penicillin V (500 mg orally twice daily for 10 days) or amoxicillin (500 mg orally three times daily for 10 days) 3

For pregnant women without a history of anaphylaxis, the Centers for Disease Control and Prevention recommend cefazolin as the preferred alternative to penicillin, due to its safety profile and efficacy 4, 5, 6, 7, 8
For pregnant women at high risk for anaphylaxis, the Infectious Diseases Society of America recommends clindamycin (300 mg orally four times daily for 10 days) if susceptibility testing confirms the streptococcal isolate is susceptible to clindamycin, with a strength of evidence rated as moderate 9

The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend avoiding the use of tetracyclines (including doxycycline), aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones during pregnancy, due to their potential fetal risks, with a strength of evidence rated as high 1, 2

The Infectious Diseases Society of America recommends that treatment should be based on positive throat culture or rapid antigen detection testing (RADT) for group A streptococci, with a strength of evidence rated as high 3
Withholding antibiotics in patients with negative microbiological tests is a quality care indicator, with a strength of evidence rated as moderate 3
A full 10-day course of antibiotics is essential to prevent rheumatic fever and ensure bacterial eradication, regardless of symptom improvement, with a strength of evidence rated as high 3
Asymptomatic carriers do not require treatment, as antimicrobial therapy is much less effective at eradicating group A streptococci from carriers than from patients with acute infections, with a strength of evidence rated as moderate 3